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01-04-2015 | Maternal-Fetal Medicine

Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review

Authors: Stella D’Arpe, Silvia Franceschetti, Roberto Corosu, Innocenza Palaia, Violante Di Donato, Giorgia Perniola, Ludovico Muzii, Pierluigi Benedetti Panici

Published in: Archives of Gynecology and Obstetrics | Issue 4/2015

Abstract

Purpose

To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data.

Methods

Retrospective study of 51 patients who underwent EPH at the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2000 to December 2013. Maternal characteristics of the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Fisher’s and Chi-square tests were performed for statistical analysis.

Results

There were 51 EPH out of 23,384 deliveries, for an incidence of 2.2 per 1,000 deliveries during the study period. Forty-nine EPHs were performed after caesarean delivery (CS) and two after vaginal delivery (p < 0.0001). The most common indications were abnormal placentation (49.0 %), followed by uterine atony (41.2 %), and uterine rupture (9.8 %). Eighty percent of patients who underwent EPH with abnormal placentation had at least one previous CS (p < 0.01). Twenty-three patients (45.1 %) underwent total hysterectomy, the most frequent indication being abnormal placentation (76 %, p < 0.01). The remaining 28 patients underwent subtotal hysterectomy (54.9 %), the most frequent indication being uterine atony (85.7 %, p < 0.01). Maternal morbidity was 25.5 % and mortality was 5.9 %. Perinatal mortality was 3.9 %.

Conclusions

Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.

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Title: Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review
Authors: Stella D’Arpe
Silvia Franceschetti
Roberto Corosu
Innocenza Palaia
Violante Di Donato
Giorgia Perniola
Ludovico Muzii
Pierluigi Benedetti Panici
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-014-3487-y

At a glance: The STEP trials

Springer Medicine

Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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